care

admission care in the nursing interventions classification, a nursing intervention defined as facilitating entry of a patient into a health care facility.

adult day care a health care service provided for adults with a disability or illness who need partial or supplemental care and companionship during the day, when family members are working or otherwise unable to stay at home with a disabled relative. Among the services that may be offered at an adult day care center are nursing services (e.g., medication administration and health monitoring); nutritional and health education, health counseling; physical, speech, and occupational therapy; and socialization.

ambulatory care health services or acute care services that are provided on an outpatient basis.

amputation care in the nursing interventions classification, a nursing intervention defined as the promotion of physical and psychological healing after amputation of a body part.

bed rest care in the nursing interventions classification, a nursing intervention defined as promotion of comfort and safety and prevention of complications for a patient unable to get out of bed. See also bed rest.

bowel incontinence care in the nursing interventions classification, a nursing intervention defined as promotion of bowel continence and maintenance of perianal skin integrity.

bowel incontinence care: encopresis in the nursing interventions classification, a nursing intervention defined as promotion of bowel continence in children.

cardiac care in the nursing interventions classification, a nursing intervention defined as the limitation of complications resulting from an imbalance between myocardial oxygen supply and demand for a patient with symptoms of impaired cardiac function.

cardiac care: acute in the nursing interventions classification, a nursing intervention defined as the limitation of complications for a patient recently experiencing an episode of an imbalance between myocardial oxygen supply and demand resulting in impaired cardiac function.

cardiac care: rehabilitative in the nursing interventions classification, a nursing intervention defined as the promotion of maximal functional activity level for a patient who has suffered an episode of impaired cardiac functon which resulted from an imbalance between myocardial oxygen supply and demand.

cast care activities and interventions designed to protect and maintain an immobilized body part, including relief of pain, pressure or constriction of circulation. See also hazards of immobility.

cast care: maintenance in the nursing interventions classification, a nursing intervention defined as care of a cast after the drying period.

cast care: wet in the nursing interventions classification, a nursing intervention defined as care of a new cast during the drying period.

cesarean section care in the nursing interventions classification, a nursing intervention defined as the preparation and support of a patient delivering a baby by cesarean section.

circulatory care: mechanical assist device in the nursing interventions classification, a nursing intervention defined as temporary support of the circulation through the use of mechanical devices or pumps.

contact lens care in the nursing interventions classification, a nursing intervention defined as the prevention of eye injury and lens damage by proper use of contact lenses.

continuing care the level of care in the health care system that consists of ongoing care of the physically handicapped, mentally retarded, emotionally retarded, and those suffering from chronic incapacitating illness.

cord care specialized care of the remnants of a newborn's umbilical cord until it falls off, consisting of cleaning and precautions to prevent infection. Cleansing protocols continue until the site is completely healed.

culture-specific care those assistive, supportive, or facilitative acts toward or for an individual or group with evident or anticipated needs that are congruent with the values and lifestyles of an individual, family, or group of a specific culture, as used in the cultural care diversity and universality theory.

day care/respite in the omaha system, the providing by an individual or institution of supervision for a dependent child or adult in the abscence of the usual caregiver or parent.

developmental care in the nursing interventions classification, a nursing intervention defined as structuring the environment and providing care in response to the behavioral cues and states of the preterm infant.

direct care the provision of services to a patient that require some degree of interaction between the patient and the health care provider. Examples include assessment, performing procedures, teaching, and implementation of a care plan.

dying care in the nursing interventions classification, a nursing intervention defined as promotion of physical comfort and psychological peace in the final phase of life. See also dying.

ear care in the nursing interventions classification, a nursing intervention defined as prevention or minimization of threats to ear or hearing.

embolus care: peripheral in the nursing interventions classification, a nursing intervention defined as limitation of complications for a patient experiencing, or at risk for, occlusion of peripheral circulation. See also embolus.

embolus care: pulmonary in the nursing interventions classification, a nursing intervention defined as limitation of complications for a patient experiencing, or at risk for, occlusion of pulmonary circulation. See also embolus.

emergency care in the nursing interventions classification, a nursing intervention defined as providing life-saving measures in life-threatening situations. See also emergency.

eye care in the nursing interventions classification, a nursing intervention defined as the prevention or minimization of threats to eye or visual integrity.

family-centered maternity care a pattern of caring for infants and their families used by Health and Welfare Canada. It is characterized by a great deal of flexibility and parental choice, and health care professionals are encouraged to individualize care. Breast feeding and rooming in are encouraged and grandparent and sibling visits are permitted.

foot care see foot care.

hair care in the nursing interventions classification, a nursing intervention defined as the promotion of neat, clean, and attractive hair.

high-risk pregnancy care in the nursing interventions classification, a nursing intervention defined as identification and management of a high-risk pregnancy to promote healthy outcomes for mother and baby.

incision site care in the nursing interventions classification, a nursing intervention defined as cleansing, monitoring, and promotion of healing in a wound that is closed with sutures, clips, or staples.

indirect care services that are related to patient care but do not require interaction between the health care provider and the patient. Examples include charting and scheduling.

infant care in the nursing interventions classification, a nursing intervention defined as the provision of developmentally appropriate family-centered care to the child under one year of age.

kangaroo care in the nursing interventions classification, a nursing intervention defined as promoting closeness between parent and physiologically stable preterm infant by preparing the parent and providing the environment for skin-to-skin contact.

long-term care health care services required for an extended period of time by individuals unable to fully execute activities of daily living; it can be provided by a variety of agencies in outpatient settings as well as on an inpatient basis.

managed care a method of health care delivery that focuses on collaboration among and coordination of all services to avoid overlap, duplication, and delays and to reduce costs. There is an emphasis on efficacy and timeliness of interventions to prevent unnecessary delays in discharge from the hospital or agency.

medical/dental care in the omaha system, diagnosis and treatment by a physician or dentist.

nail care in the nursing interventions classification, a nursing intervention defined as promotion of clean, neat, attractive nails and prevention of skin lesions related to improper care of nails.

newborn care in the nursing interventions classification, a nursing intervention defined as management of the neonate during the transition to extrauterine life and the subsequent period of stabilization.

1. care of the pregnant woman before delivery of the infant. See also pregnancy.

2. in the nursing interventions classification, a nursing intervention defined as monitoring and management of the patient during pregnancy to prevent complications of pregnancy and promote a healthy outcome for both mother and infant.

primary care the routine outpatient care that a patient receives at first contact with the health care system.

prosthesis care in the nursing interventions classification, a nursing intervention defined as the care of a removable appliance worn by a patient and the prevention of complications associated with its use. See also prosthesis.

sickness/injury care in the omaha system, the appropriate responses to illness or accidents, including first aid, taking temperature, and seeking medical care.

skilled nursing care the services provided by a registered nurse in a skilled nursing facility. It currently includes observation during periods of acute or unstable illness; administration of intravenous fluids, enteral feedings, and intravenous or intramuscular medications; short-term bowel and bladder retraining; and changing of sterile dressings.

skin care activities and interventions designed to maintain integrity of integument, including care of pressure ulcers and massage.

skin care: topical treatments in the nursing interventions classification, a nursing intervention defined as the application of topical substances or manipulation of devices to promote skin integrity and minimize skin breakdown.

subacute care comprehensive goal-oriented inpatient care designed for a patient who has had an acute illness, injury, or exacerbation of a disease process; it is rendered either immediately after or instead of acute care hospitalization, to treat specific active or complex medical conditions or to administer any necessary technically complex medical treatments in the context of the person's underlying long-term condition.

supportive care interventions that help the patient achieve comfort but do not affect the course of a disease. Called also palliative care or treatment.

tertiary care the level of care in the health care system that consists of complex procedures given in a health care center that has highly trained specialists and often advanced technology.

total patient care a method of organizing care of patients such that one practitioner carries out all care requirements.

traction/immobilization care in the nursing interventions classification, a nursing intervention defined as management of a patient who has traction and/or a stabilizing device to immobilize and stabilize a body part.

tube care in the nursing interventions classification, a nursing intervention defined as management of a patient with an external drainage device exiting the body.

tube care: chest in the nursing interventions classification, a nursing intervention defined as management of a patient with an external water-seal drainage device exiting the chest cavity.

tube care: gastrointestinal in the nursing interventions classification, a nursing intervention defined as management of a patient with a gastrointestinal tube.

tube care: umbilical line in the nursing interventions classification, a nursing intervention defined as management of a newborn with an umbilical catheter.

tube care: urinary in the nursing interventions classification, a nursing intervention defined as management of a patient with urinary drainage equipment.

tube care: ventriculostomy/lumbar drain in the nursing interventions classification, a nursing intervention defined as management of a patient with an external cerebrospinal fluid drainage system. See also ventriculostomy and drain.

urinary incontinence care in the nursing interventions classification, a nursing intervention defined as assistance in promoting continence and maintaining perineal skin integrity. See also urinary incontinence.

urinary incontinence care: enuresis in the nursing interventions classification, a nursing intervention defined as promotion of urinary continence in children.

wound care: closed drainage in the nursing interventions classification, a nursing intervention defined as maintenance of a pressure drainage system at the wound site.

mouth

[mowth]

1. an opening or aperture.

2. the oral cavity, which forms the beginning of the digestive system and in which the chewing of food takes place. The mouth is also the site of the organs of taste and of the teeth, tongue, and lips. It is not only the entrance to the body for food and sometimes air, but also a major organ of speech and emotional expression.

Structure. Except for the teeth, the interior of the mouth is covered with mucous membrane. This thin lining extends out from the front of the mouth to form the lips. Salivary glands lie above and below the mouth and produce saliva, a liquid that protects the delicate membranes and mixes with food in the first step of digestion of food.

The palate forms the roof of the mouth. The front two thirds of the palate comprises the hard palate, and the back third, the soft palate. The soft palate is hinged to the hard palate and is flanked on both sides by the tonsils. In the middle of the soft palate is the uvula, a projection pointing down to the tongue. At the root of the tongue, below the uvula, lies the epiglottis.

Disorders. Because of its special functions the mouth is constantly exposed to infection and irritation. These can affect the whole mouth generally or only certain parts, such as the tongue. Inflammation of the mouth, or stomatitis, can indicate the presence of either a mild or severe disease. Local conditions include thrush, gingivitis, and herpes simplex. Generalized diseases can also give rise to inflammation of the mouth; these include diphtheria, tuberculosis, blood dyscrasias, vitamin deficiencies, and syphilis.

Cancer can afflict the sides of the mouth, the lips, the tongue, and occasionally the salivary glands. Continued irritation, such as pipe smoking, is thought to be a cause of many mouth cancers. Any persistent sore or swelling should be promptly examined by a health care worker.

Birth defects affecting the mouth include cleft lip and cleft palate. Both have the same cause: failure of adjacent parts of the body to unite properly in fetal life. A cleft lip (popularly called “harelip”) involves a split in the upper lip. Sometimes the cleft extends into the upper jaw, the floor of the nose, and the palate. The resulting deformity of nose and mouth interferes with sucking and speech unless corrected by surgery. A cleft palate, which may cause difficulties in speaking and eating, signifies a cleavage in the uvula and the soft palate. Both conditions can be successfully corrected by surgery.

mouth care techniques of oral hygiene whose purpose is to preserve or restore and maintain normal physiology and function of the oral cavity. These include assessment of the mouth, cleaning, and removal of debris from the teeth, palate, tongue, and sides of the mouth. Periodically and systematically cleaning the mouth, brushing the teeth, and flossing help prevent dental caries, inflammatory periodontal disease, and halitosis. Mouth care also promotes a sense of cleanliness and well-being, facilitates speech, and helps overcome loss of appetite. Additionally, a healthy oral mucosa is the first line of defense against infection in the oral cavity.

In the normal mouth a healthy oral mucosa is maintained in part by movements of the tongue, lips, and cheeks during speech, chewing, and swallowing. Salivation and the mechanical action of chewing foods also help keep the mucosa soft and moist. Brushing and flossing or other less forceful measures facilitate removal of debris, bacteria, and plaque and preserve the integrity of the teeth and gums.

Patients most in need of special mouth care include those who (1) breathe through their mouths because of nasal obstruction or other conditions, (2) are receiving nasal oxygen, (3) have a restricted oral intake or are being fed by tube, (4) are comatose or otherwise unable to care for their teeth and mouth, (5) are receiving radiation therapy to the head and neck, or (6) are receiving chemotherapy for a malignancy. Both radiation and chemotherapy can cause severe stomatitis and xerostomia.

Initial and ongoing assessment of the oral cavity can establish the type and frequency of mouth care needed. In general, the more easily damaged the integrity of the oral mucosa, the more gentle the chemical and mechanical cleansing. If brushing with a soft nylon toothbrush and nonabrasive toothpaste and flossing cannot be tolerated, the teeth can be cleaned with unflavored oral care sponges dipped into plain water or a physiologic saline solution. Flossing is contraindicated if the patient has a low platelet count or low white cell count. Mouthwashes are not a substitute for toothbrushing.

Xerostomia (excessive dryness of the mouth) can be relieved by artificial saliva or by application of a water soluble lubricant such as KY jelly. If the patient is able to eat and drink, fluids and moist foods are encouraged. Dry, cracked lips respond best to petroleum jelly or a camphor-based lip balm. Lemon juice and glycerin are not recommended in patients with mucositis because when used over a period of time glycerin tends to dry oral tissues.

Thick and tenacious mucus in the oral cavity can be removed by diluted hydrogen peroxide or socium bicarbonate solution. The hydrogen peroxide solution is prepared by mixing equal parts hydrogen peroxide (USP 3 per cent) and water just before application. A peroxide solution is contraindicated if the patient has leukemia or there are freshly granulating surfaces or exposed bone in the oral cavity. Sodium bicarbonate solution is made by adding one teaspoon of sodium bicarbonate to one pint (half a liter) of water. The same proportions of salt and water are used to prepare a 0.9 per cent solution of normal saline.

If pain in the mouth prevents a patient from eating comfortably, it may be possible to provide temporary relief by rinsing the mouth with a solution of one part lidocaine viscous 2 per cent added to two parts water. However, since this solution diminishes sensitivity to heat, the patient must not be fed hot food or drinks that could cause burns.

Diligent, systematic mouth care is an integral part of hospital care. Research has shown that such care prevents many problems of nutrition, infection, and pain associated with stomatitis, especially those occurring as a complication of chemotherapy and radiation therapy. Moreover, routine care of the mouth, teeth, and gums, no matter what the health status of the patient, can prevent many problems, maintain a healthy oral cavity, and do much to make the patient more comfortable.

mouth care

Personal and bedside care of the oral cavity including the gingivae, teeth, lips, epithelial covering of the mucosa, pharynx, and tongue. People who are normally able to provide their own oral hygiene may require help in maintaining a healthy oral environment when they are ill. The intensity and frequency of care is dictated by the patient's comfort; the severity of the illness; potential or existing irritation or inflammation secondary to trauma or therapy; and the patient's state of consciousness, level of cooperation, and ability to care for himself or herself.

Our review of the literature on oral care demonstrated that other units apart from ours raise concerns that providing and documenting mouth care can vary from one to eight hours, indicating a wide variance in nursing practice and the provision of suboptimal care (Goss et al.

Grap and Munro (2004) presented supporting evidence indicating that critically ill patients who are intubated for more than 24 hours are at higher risk for VAP, and therefore, mouth care and oral health should be an important part of nursing care.

It involved programs at the level of frontline care to assist those who require assistance with mouth care, toothbrushing, cleaning dentures, and attending to discomforts or difficulties associated with eating, speaking, and so on.

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